Article type
Year
Abstract
Background: The use of opioids for chronic non-cancer pain (CNCP) has increased rapidly in the last 15 years. However, the effectiveness of opioids for CNCP remains unsupported by good quality evidence, and adverse effects on multiple organ systems are increasingly documented. Opioids are often used at high doses and/or in combination with other psychoactive medications. CNCP has been regarded as purely physical, although its etiology is unknown in most cases, and it is often associated with psychiatric conditions and emotional distress.
Objectives: To create a knowledge base and framework for informed discussion of the risks and benefits of opioid and other medication use for CNCP.
Methods: A community-wide coalition of public health, medical, education, law enforcement and treatment professionals in Marin County, California (Rx Safe Marin) developed evidence-based provider recommendations for this discussion, and associated community education resources. A parallel effort is underway at medical groups in the County. The American College of Occupational and Environmental Medicine has included recommendations for this discussion in its recently updated opioid guideline as well.
Results: The evidence for the effectiveness of opioids for CNCP and adverse effects were reviewed. A framework for periodic informed consent and shared decision making discussions was developed, that was similar in all three organizations. Provider material includes a series of case studies and video vignettes for communication about difficult issues and patient concerns. Rx Safe Marin and associated provider groups are monitoring adverse event rates and prescription rates, and working on documentation of shared decision making and informed consent.
Conclusions: The wide spread effects of opioids on multiple organ systems, beyond addiction, dependence, overdose and death, balanced against the still unproven effectiveness of opioids for CNCP should be carefully considered in a shared decision-making/informed consent framework when making treatment decisions.
Objectives: To create a knowledge base and framework for informed discussion of the risks and benefits of opioid and other medication use for CNCP.
Methods: A community-wide coalition of public health, medical, education, law enforcement and treatment professionals in Marin County, California (Rx Safe Marin) developed evidence-based provider recommendations for this discussion, and associated community education resources. A parallel effort is underway at medical groups in the County. The American College of Occupational and Environmental Medicine has included recommendations for this discussion in its recently updated opioid guideline as well.
Results: The evidence for the effectiveness of opioids for CNCP and adverse effects were reviewed. A framework for periodic informed consent and shared decision making discussions was developed, that was similar in all three organizations. Provider material includes a series of case studies and video vignettes for communication about difficult issues and patient concerns. Rx Safe Marin and associated provider groups are monitoring adverse event rates and prescription rates, and working on documentation of shared decision making and informed consent.
Conclusions: The wide spread effects of opioids on multiple organ systems, beyond addiction, dependence, overdose and death, balanced against the still unproven effectiveness of opioids for CNCP should be carefully considered in a shared decision-making/informed consent framework when making treatment decisions.